Mad in the USASeveral Hundred Thousand Mentally Ill
Prisoners Warehoused
in Correctional Facilities Throughout the Country by Bill Berkowitzwww.dissidentvoice.org
November 24,
2003

"They
are afflicted with delusions and hallucinations, debilitating fears, extreme
and uncontrollable mood swings," reads a disturbing paragraph from a recent
Human Rights Watch report. "They huddle silently in their cells, mumble
incoherently, or yell incessantly. They refuse to obey orders or lash out
without apparent provocation. They beat their heads against cell walls,
smear themselves with feces, self-mutilate, and commit suicide." This
description isn't about conditions faced by prisoners in a gulag in the old
Soviet Union, it isn't detailing life in one of Saddam Hussein's hell holes,
and it isn't about a concentration camp in some far-off place. This is a
description of the situation too many mentally ill prisoners are subjected
to in U.S. correctional facilities in 2003.

According to "Ill-Equipped:
U.S. Prisons and Offenders with Mental Illness", written by Sasha
Abramsky, a consultant to Human Rights Watch, and Jamie Fellner, director of
the U.S. Program at HRW, people "with mental illness are disproportionately
represented in correctional institutions." One in six U.S. prisoners is
mentally ill and suffering "from serious illnesses such as schizophrenia,
bipolar disorder, and major depression." Each day, some seventy thousand are
psychotic. "There are three times as many men and women with mental illness
in U.S. prisons as in mental health hospitals. The rate of mental illness in
the prison population is three times higher than in the general population."

"On any given day, at least
284,000 schizophrenic and manic depressive individuals are incarcerated, and
547,800 are on probation. We have unfortunately come to accept incarceration
and homelessness as part of life for the most vulnerable population among
us." Congressman Ted Strickland told the House Subcommittee on Crime,
Oversight Hearing on "The Impact of the Mentally Ill on the Criminal Justice
System," in September 2000.

The mentally ill in prison
are easy prey, and "are likely to be picked on, physically or sexually
abused, and manipulated by other inmates, who call them 'bugs,'" the Human
Rights Watch (HRW) report charges.

Based on an exhaustive
two-year study that included interviews with hundreds of prisoners,
corrections officials, mental health experts and attorneys, the 215-page
Human Rights Watch (HRW) report maintains that the mentally-ill are
warehoused without proper treatment -- in many cases without any treatment
at all -- "because of a shortage of qualified staff, lack of facilities, and
prison rules that interfere with treatment." The report focuses on the adult
prison population, who are housed in nearly fourteen hundred adult state and
federal prisons across the country.

Although some prisoners are
receiving adequate mental health services from "competent and committed
mental health professionals" prisons operate under "rules designed for
punishment," -- not treatment. In addition, the "fiscal crisis" of most
states threatens to torpedo the decent programs currently in place.

"In the most extreme
cases," however, conditions of mentally ill prisoners "are truly horrific:
[they are]... locked in segregation with no treatment at all; confined in
filthy and beastly hot cells; left for days covered in feces they have
smeared over their bodies; taunted, abused, or ignored by prison staff;
given so little water during summer heat waves that they drink from their
toilet bowls."

The report attributes the
criminalization of persons with mental illness to the closure of state
mental hospitals and failure of communities to provide adequate treatment
and support. In state after state, the dollars that once funded state
hospitals did not follow mentally ill individuals to their communities. At
least a third of the homeless population is mentally ill -- many with
co-occurring substance abuse. "Many people with mental illness --
particularly those who are poor, homeless, or struggling with substance
abuse problems -- cannot get mental health treatment. If they commit a
crime, even low-level nonviolent offenses, punitive sentencing laws mandate
imprisonment."

In July, the President's
New Freedom Commission on Mental Health issued "Achieving the Promise:
Transforming Mental Health Care in America." The Commission found a system
in shambles and concluded that there needs to be an "overhaul of the system
-- focusing on early diagnosis and treatment -- that will enable people with
mental illness to live, work and fully participate in their communities --
and live meaningful lives." The report also found that "there are many unmet
needs and barriers to care for people with mental illness. And despite an
increased scientific knowledge base that has led to many effective
treatments, many Americans are not receiving the benefits. Too often,
treatments and services are unaffordable and uneasy to access."

Over the past twenty years,
the politics of lock-em-up-as-fast-as-possible became the anti-crime mantra
of most politicians. Hundreds of thousands of victims of the "war on drugs"
were imprisoned. As the rate of incarceration soared so did the prison
population of mentally ill inmates.

The Human Rights Watch (HRW)
report is only the most recent work documenting the inhumane conditions of
the mentally ill in prison. In 1999, in his groundbreaking work, "Prison
Madness: The Mental Health Crisis Behind Bars and What We Must Do About It"
(Jossey-Bass, 1999), Dr. Terry Kupers fired an early warning shot, alerting
the public to a "major crisis brewing in our prisons": "We are warehousing
and mistreating a huge number of mentally ill people... and many people are
unaware of its ramifications," Dr. Kupers wrote. Prison policies add to the
problem by "traumatizing formerly 'normal' prisoners and making them angry,
violent, and vulnerable to severe emotional problems."

Dr. Kupers, a psychiatrist
and professor at the Wright Institute of Psychology in Berkeley, California,
is a longtime advocate for the humane treatment of prisoners, and has
testified as an expert witness on behalf of prisoners in more than a dozen
class action lawsuits. "The deinstitutionalization of the public mental
health system, combined with changes in the law that make it far less likely
that a defendant's mental illness will be considered a mitigating factor
when sentences are being decided, has put an unprecedented number of
Americans with major psychiatric problems in the criminal justice system,"
Kupers wrote.

According to the HRW
report, funding cutbacks threaten reform efforts just when prison officials
are being forced to institute change. "Litigation or the threat of it," the
report argues "is the prerequisite for systematic improvements in mental
health services," Improvements in conditions in such states as Alabama,
Arizona, California, Florida, Indiana, Iowa, Louisiana, Michigan, New
Mexico, New Jersey, New York, Ohio, Texas, Vermont, Washington, and
Wisconsin have come about as a result of class action law suits.

Litigation has been
successful, with numerous consent decrees in place to mandate improved
mental health services. Still HRW finds "some correctional authorities
resist putting reforms in place" because of "institutional inertia,
bureaucratic obstacles, failure to understand the importance of adequate
mental health services, or the lack of funding."

The HRW authors were unable
to determine "figures for total national expenditures on prison mental
health services," and "many individual prison systems... indicated they were
unable to calculate the portion of their medical budgets devoted to mental
health services." Mental health treatment, medications, and additional
correctional staff for inmate supervision do not come cheap. Providing for
these services is first on most states' budgetary agendas. For example,
Michigan, a state praised by HRW for "dramatic improvements" in correctional
mental health services, cut $5 million of its $72 million budget and reduced
50 mental health positions in 2002.

"No set of changes limited
to jail and prison mental health programs will fix the larger problem," Dr.
Terry Kupers, who consulted with the authors of the report, told me in a
phone conversation. "Of course it would help a little to double or triple
the number of psychiatric hospital beds within the prisons, or to expand
diversion programs, but that would not alter the fact that with the widening
gap between rich and poor a whole lot of people suffering from mental
illness are disappeared into our jails and prisons.

"We have to halt the
heartless dismantling of the social safety net, including public mental
health services. We have to end the racism that's rampant in the criminal
justice system. The Human Rights Watch report reminds us that prisoners are
human beings, and we have a social responsibility to do something about
their pain and suffering."

Bill Berkowitz
is a longtime observer of the conservative movement. His
WorkingForChange.com column Conservative Watch documents the strategies,
players, institutions, victories and defeats of the American Right.